The concentration of lipopolysaccharide on individual root surfaces at varying times following in vivo root planing

A re-evaluation of scaling and root planing

BACKGROUND

Extensive reviews on the role of scaling and root planing (SRP) in the treatment of periodontitis have been previously published. This commentary will address the importance of subgingival calculus in the progression and treatment of periodontitis and addresses factors that make the execution of a "definitive" SRP a critical part of therapy.

METHODS

A search for articles, using keywords relevant to the subject , (e.g., periodontitis, dental scaling, root planing, dental calculus, biofilm, inflammation) was conducted using PubMed, Ovid Medline, Cochrane Reviews and the ADA Center for Evidence Based Dentistry data bases. Additionally, references cited in relevant articles were also considered.

RESULTS

Surfaces of subgingival calculus are covered with a biofilm of metabolically active bacteria. Periodontal inflammation is clearly related to the presence of calculus and biofilm. The primary goal of SRP is removal of subgingival calculus and biofilm deposits to create a biologically compatible root surface and reduce the inflammatory burden. Current evidence suggests that inflammation associated with periodontal infections affects both the immediate oral environment and the patient's systemic health.

CONCLUSION

SRP is still critical to the treatment of periodontitis. SRP involving deep probing depths (≥ 5 mm) and root surfaces with anatomical and surface irregularities, regardless of the type of instrumentation, requires time, exceptional skill and perseverance, and patient compliance with periodontal maintenance. Sites with persistent nonresponding probing depths and signs of inflammation following a definitive SRP, should be considered for surgical intervention.

The oral microbial consortium's interaction with the periodontal innate defense system

The oral microbial consortium is the most characterized polymicrobial microbial community associated with the human host. Extensive sampling of both microbial and tissue samples has demonstrated that there is a strong association between the type of microbial community found in the gingival crevice and the status of innate host mediator expression. The strong clinical association between the microbial community and the innate host response in both clinically healthy and diseased tissue suggests that the oral consortium has a direct effect on periodontal tissue expression of innate defense mediators. A preliminary study in germ-free mice has demonstrated that the oral commensal consortium has direct effect on IL-1beta expression, indicating that this microbial community may contribute to the strong protective status of healthy gingival tissue. Likewise, the lipopolysaccharide composition and invasion characteristics of Porphyromonas gingivalis, an oral bacterium strongly associated with periodontitis, suggest that it may be a keystone member of the oral microbial community and facilitate a destructive change in the protective gingival innate host status.

Porphyromonas gingivalis lipopolysaccharide displays functionally diverse interactions with the innate host defense system

Periodontitis is a bacterially induced chronic inflammatory disease and a major cause of tooth loss in the world. The tissue damage and alveolar bone resorption characteristic of the disease are believed to be due to a destructive innate host response to a pathogenic subgingival biofilm. Porphyromonas gingivalis, a Gram-negative bacterium, is a member of this mixed microbial community that has been designated an etiologic agent of periodontitis. The innate host response to lipopolysaccharide (LPS) obtained from P. gingivalis is unusual in that different studies have reported that it can be an agonist for Toll-like receptor (TLR) 2 as well as an antagonist or agonist for TLR4. In addition, human monocytes respond to this LPS by secreting a variety of different inflammatory mediators, while endothelial cells do not. We have examined highly purified preparations of P. gingivalis LPS and found that they activate both TLR2 combined with TLR1 and TLR4 in transiently transfected human embryonic kidney (HEK) 293 cells. We have further demonstrated that highly purified P. gingivalis LPS preparations contain at least 3 major different lipid A species. We speculate that P. gingivalis lipid A structural heterogeneity contributes to the unusual innate host response to this LPS and its ability to interact with different TLR molecules.

Root surface removal and resultant surface texture with diamond-coated ultrasonic inserts: an in vitro and SEM study

BACKGROUND

A new diamond-coated ultrasonic insert has been developed for scaling and root planing, and it was evaluated in vitro for the amount of root surface removed and the roughness of the residual root surface as a result of instrumentation.

METHODS

48 extracted single-rooted human teeth were ground flat on one root surface and mounted (flat side up) in PVC rings of standard height and diameter with improved dental stone. Each tooth surface was treated with either a plain ultrasonic insert (PI), an ultrasonic insert with a fine grit diamond coating (DI) or sharp Gracey curettes (HI). The mounted teeth were attached to a stepper motor which drove the teeth in a horizontal, reciprocal motion at a constant rate. The thickness from the flattened bottom of the ring to the flattened tooth surface was measured before and after 10, 20, and 30 instrumentation strokes for each root surface with each of the experimental instruments. A number of treated teeth were randomly selected for examination with SEM and a profilometer. Statistical analysis (analysis of co-variance) was performed to compare the amounts of tooth structure removed among the 3 instruments and t-test was used to compare the roughness of the treated root surfaces.

RESULTS

The mean depth of root structure removed was PI 10.7 microm, HI 15.0 microm, and DI 46.2 microm after 10 strokes; and PI 21.6 microm, HI 33.2 and DI 142.0 microm after 30 strokes, respectively. On average, 0.9 microm, 1.3 microm, and 4.7 microm of root surface was removed with each stroke of PI, HI and DI, respectively. PI and HI were not different from each other for all the stroke cycles, while DI was significantly different from PI and HI for all the stroke cycles (p<0.0001). Analysis with the profilometer showed that the smoothest surface was produced by the PI followed by the HI. The DI produced a surface that was significantly rougher than the surface produced by the PI or HI.

CONCLUSION

These results suggest that diamond-coated ultrasonic instruments will effectively plane roots, and that caution should be used during periodontal root planing procedures. Additionally, the diamond-coated instruments will produce a rougher surface than the plain inserts or the hand curettes.

Porphyromonas gingivalis lipopolysaccharide contains multiple lipid A species that functionally interact with both toll-like receptors 2 and 4

The innate host response to lipopolysaccharide (LPS) obtained from Porphyromonas gingivalis is unusual in that different studies have reported that it can be an agonist for Toll-like receptor 2 (TLR2) as well as an antagonist or agonist for TLR4. In this report it is shown that P. gingivalis LPS is highly heterogeneous, containing more lipid A species than previously described. In addition, purification of LPS can preferentially fractionate these lipid A species. It is shown that an LPS preparation enriched for lipid A species at m/z 1,435 and 1,450 activates human and mouse TLR2, TLR2 plus TLR1, and TLR4 in transiently transfected HEK 293 cells coexpressing membrane-associated CD14. The HEK cell experiments further demonstrated that cofactor MD-2 was required for functional engagement of TLR4 but not of TLR2 nor TLR2 plus TLR1. In addition, serum-soluble CD14 effectively transferred P. gingivalis LPS to TLR2 plus TLR1, but poorly to TLR4. Importantly, bone marrow cells obtained from TLR2(-/-) and TLR4(-/-) mice also responded to P. gingivalis LPS in a manor consistent with the HEK results, demonstrating that P. gingivalis LPS can utilize both TLR2 and TLR4. No response was observed from bone marrow cells obtained from TLR2 and TLR4 double-knockout mice, demonstrating that P. gingivalis LPS activation occurred exclusively through either TLR2 or TLR4. Although the biological significance of the different lipid A species found in P. gingivalis LPS preparations is not currently understood, it is proposed that the presence of multiple lipid A species contributes to cell activation through both TLR2 and TLR4.

Porphyromonas gingivalis lipopolysaccharide is both agonist and antagonist for p38 mitogen-activated protein kinase activation

Lipopolysaccharide (LPS) is a key inflammatory mediator. It has been proposed to function as an important molecule that alerts the host of potential bacterial infection. Although highly conserved, LPS contains important structural differences among different bacterial species that can significantly alter host responses. For example, LPS obtained from Porphyromonas gingivalis, an etiologic agent for periodontitis, evokes a highly unusual host cell response. Human monocytes respond to this LPS by the secretion of a variety of different inflammatory mediators, while endothelial cells do not. In addition, P. gingivalis LPS inhibits endothelial cell expression of E-selectin and interleukin 8 (IL-8) induced by other bacteria. In this report the ability of P. gingivalis LPS to activate p38 mitogen-activated protein (MAP) kinase was investigated. It was found that p38 MAP kinase activation occurred in response to P. gingivalis LPS in human monocytes. In contrast, no p38 MAP kinase activation was observed in response to P. gingivalis LPS in human endothelial cells or CHO cells transfected with human Toll-like receptor 4 (TLR-4). In addition, P. gingivalis LPS was an effective inhibitor of Escherichia coli-induced p38 MAP kinase phosphorylation in both endothelial cells and CHO cells transfected with human TLR-4. These data demonstrate that P. gingivalis LPS activates the LPS-associated p38 MAP kinase in monocytes and that it can be an antagonist for E. coli LPS activation of p38 MAP kinase in endothelial and CHO cells. These data also suggest that although LPS is generally considered a bacterial component that alerts the host to infection, LPS from P. gingivalis may selectively modify the host response as a means to facilitate colonization.

Effect of pH on endotoxin affinity for metal-ceramic alloys

STATEMENT OF PROBLEM

Crevicular pH may modify bacterial endotoxin affinity for high-noble metal-ceramic alloys.

PURPOSE

Porphyromonas gingivalis lipopolysaccharide (LPS) affinity for 3 metal-ceramic alloys at 3 different pH levels was compared in vitro by measuring adsorption to and release from the alloy surface.

MATERIAL AND METHODS

Metallographically polished disks were fabricated from Pd-Ag-Sn, Au-Pd-Ag-Sn-In, and Au-Pd-In-Ga alloys. Clean disks were placed individually into 1 mL at pH 6.5, 7.0, or 7.5 phosphate-buffered saline solution containing 0.9 endotoxin units per square millimeter tritiated LPS (n = 3 disks per alloy-pH group). The disks were incubated for 24 hours at 37 degrees C before being transferred to LPS-free buffer and incubated, again for 24 hours at 37 degrees C, to evaluate elution. This transfer continued at 24-hour intervals up to 96 hours total elution incubation. Lipopolysaccharide adsorption to and elution from disks was determined through liquid scintillation spectrometry. Adsorption data were evaluated with a 2-way analysis of variance (alpha=.05) and the post hoc Tukey honestly significant difference test.

RESULTS

Lipopolysaccharide adsorption values ranged from 0.48 +/- 0.04 EU/mm(2) for the Au-Pd-Ag-Sn-In alloy at pH 7.5 to 0.75 +/- 0.04 EU/mm(2) for the Pd-Ag-Sn alloy at pH 6.5. Alloy type (P=.0001) and environmental pH (P=.0001) significantly influenced adsorption. Adsorption to the Pd-Ag-Sn and Au-Pd-In-Ga alloys at pH 6.5, 7.0, and 7.5 were similar and decreased with increasing pH. In contrast, adsorption to the Au-Pd-Ag-Sn-In alloy was significantly less than to other alloys at pH 6.5 but did not differ at other pH levels. Lipopolysaccharide release from the alloy surface could not be detected.

CONCLUSION

P. gingivalis LPS affinity for metal-ceramic alloys was modified by environmental pH. The degree of LPS adsorption depended on the composition and surface chemistry of each alloy.

Porphyromonas gingivalis lipopolysaccharide: an unusual pattern recognition receptor ligand for the innate host defense system

Lipopolysaccharide (LPS) is a key inflammatory mediator. Due to its ability to potently activate host inflammatory and innate defense responses, it has been proposed to function as an important molecule that alerts the host of potential bacterial infection. However, although highly conserved, LPS contains important structural differences among different bacterial species that can significantly alter host responses. For example, LPS obtained from Porphyromonas gingivalis, an etiologic agent for periodontitis, causes a highly unusual host innate host response. It is an agonist for human monocytes and an antagonist for human endothelial cells. Correspondingly, although it activates p38 MAP kinase in human monocytes, P. gingivalis LPS does not activate p38 nor ERK MAP kinase in endothelial cells. In fact, P. gingivalis LPS is an effective inhibitor of Escherichia coli LPS induced p38 phosphorylation. These data show that P. gingivalis LPS modulates host defenses in endothelial cells by interfering with MAP kinase activation. In addition, P. gingivalis LPS is unusual in that it engages TLR-2 but not TLR-4 when examined in stably transfected CHO cell lines. We propose that, since LPS is a key ligand for the human innate host defense system, these unusual properties of P. gingivalis LPS are associated with the bacterium's role in the pathogenesis of periodontitis.

Position paper: sonic and ultrasonic scalers in periodontics. Research, Science and Therapy Committee of the American Academy of Periodontology

Ultrasonic and sonic scalers appear to attain similar results as hand instruments for removing plaque, calculus, and endotoxin. Ultrasonic scalers used at medium power seem to produce less root surface damage than hand or sonic scalers. Due to instrument width, furcations may be more accessible using ultrasonic or sonic scalers than manual scalers. It is not clear whether root surface roughness is more or less pronounced following power-driven scalers or manual scalers. It is also unclear if root surface roughness affects long-term wound healing. Periodontal scaling and root planing includes thorough calculus removal, but complete cementum removal should not be a goal of periodontal therapy. Studies have established that endotoxin is weakly adsorbed to the root surface, and can be easily removed with light, overlapping strokes with an ultrasonic scaler. A significant disadvantage of power-driven scalers is the production of contaminated aerosols. Because ultrasonics and sonics produce aerosols, additional care is required to achieve and maintain good infection control when incorporating these instrumentation techniques into dental practice. Preliminary evidence suggests that the addition of certain antimicrobials to the lavage during ultrasonic instrumentation may be of minimal clinical benefit. However, more randomized controlled clinical trials need to be conducted over longer periods of time to better understand the long-term benefits of ultrasonic and sonic debridement.

Endotoxin affinity for orthodontic brackets

Endotoxin, cell envelope lipopolysaccharide produced by gram-negative bacteria can activate an immune response through a variety of pathways. In addition, it can stimulate bone resorption and reduce the periodontal tissue's healing capacity. Previous studies have documented the affinity of lipopolysaccharide for restorative materials. This study evaluated the affinity of lipopolysaccharide for commercially available orthodontic brackets. Stainless steel, ceramic, plastic, and "gold" brackets were exposed to 10 EU/mm2radiolabeled Porphyromonas gingivalis or Escherichia coli lipolpoysaccharide in water and incubated for 24 hours at 37 degrees C. Brackets were then transferred to fresh lipopolysaccharide-free water and incubated for 24 hours at 37 degrees C to evaluate elution. This elution transfer was continued up to 96 hours total incubation. Lipopolysaccharide adherence and elution levels were calculated after treatment, and elution solutions were evaluated through liquid scintillation spectrometry. Mean initial lipopolysaccharide adherence ranged from 2.42 +/- 0.26 EU/mm2(E. coli, plastic) to 6.75 +/- 0.34 EU/mm2 (P. gingivalis, stainless steel). P. gingivalis lipopolysaccharide adherence was significantly greater than E. coli lipopolysaccharide adherence for all bracket types. Moreover, for each lipopolysaccharide type, stainless steel brackets exhibited significantly greater lipopolysaccharide adherence. Regarding elution, only the P. gingivalis lipopolysaccharide-exposed ceramic and plastic brackets at 24 hours and the stainless steel and ceramic brackets at 48 hours eluted measurable lipopolysaccharide. Results from this study demonstrate that P. gingivalis and E. coli LPS exhibit a high affinity for orthodontic brackets. In vivo, this affinity could affect the concentration of LPS in the gingival sulcus, thereby contributing to inflammation in tissues adjacent to the brackets.

Effects of irradiation of an erbium:YAG laser on root surfaces

The application of erbium:YAG laser (Er:YAG) irradiation has been investigated for periodontal therapy. The purpose of this study was to evaluate the effects of Er:YAG laser irradiation on root surfaces using a scanning electron microscope (SEM) and to determine the laser's ability to remove lipopolysaccharides (LPS). Infrared spectrophotometry was used to investigate the effects of the laser on LPS applied to root dentin pellets. Premolars extracted for orthodontic reasons were prepared for this study. The crowns were resected below the cemento-enamel junction, longitudinally sectioned, and the contents of the pulp chamber were removed. Then 15 root tips (5 x 5 x 1 mm) were classified into 3 groups of 5 each as follows: group 1, tips without any treatment; group 2, planed tips with the cement layers left untouched; and group 3, planed until the dentin surface was disclosed. The center of each specimen was used as the experimental irradiated area and the peripheral area served as a control. The quantity of vapor delivered by Er:YAG laser was highly increased, and the irradiated areas displayed little morphogenetic changes. The lyophilized sample LPS 0111 B4 from E. coli was then mixed with potassium bromide and pressed into a tablet, which was examined at 4,000-650 Kayser. The lyophilized LPS had a peak at 2.94 microns. LPS on the root dentin pellets was cleared away as much as possible by 150 washings in pyrogen-free water using an ultrasonic cleaner. Five microliters of 24 EU LPS solution was dropped on the root dentin pellets, which were then irradiated by the Er:YAG laser, and washed using the ultrasonic cleaner in pyrogen-free water. The amount of the extracted LPS solution was determined by spectrophotometer at 405 nm. The Er:YAG laser could remove 83.1% of the LPS. This study suggests that Er:YAG laser irradiation might be useful for root conditioning in periodontal therapy. However, clinical testing is necessary to establish what, if any, utility the Er:YAG laser has as a part of periodontal therapy.

Clinical evaluation of the speed and effectiveness of subgingival calculus removal on single-rooted teeth with diamond-coated ultrasonic tips

Several studies have found incomplete calculus removal during periodontal treatment with traditional hand curets, sonic, and ultrasonic instruments. This study evaluated the speed and effectiveness of subgingival calculus removal with new diamond-coated ultrasonic tips on single-rooted teeth. Single session subgingival scaling and root planing was performed on 80 teeth with 5 to 12 mm probing depths in 15 patients. Each patient provided groups of 4 teeth that were randomly treated with either hand curets (HAND); standard smooth ultrasonic tip (US); or fine grit (FINDIAM) or medium grit (MEDDIAM) diamond-coated ultrasonic tips. The time taken to reach the therapeutic endpoint of a clean, smooth root surface in a defined region on each tooth with each instrument by the 3 therapists with differing experience levels was recorded. The teeth were then atraumatically extracted, stored in a surfactant, photographed at 10X, and the percent of calculus present in the area of the pocket or on a comparable control surface calculated by histometric point counting. ANOVA and paired t tests showed that mean percent remaining calculus on treated versus control surfaces was HAND 4.6 +/- 5.3 versus 57.5 +/- 28.2, US 4.7 +/- 6.4 versus 54.4 +/- 25.9, FINDIAM 4.3 +/- 5.2 versus 37.5 +/- 22.1, and MEDDIAM 3.4 +/- 4.2 versus 50.7 +/- 20.1, respectively (all P < 0.01). The mean time in seconds to reach the clinical endpoint ranged from HAND 289 +/- 193, US 194 +/- 67, FINDIAM 167 +/- 71, to MEDDIAM 147 +/- 92. All powered instruments were significantly faster than HAND (P < 0.05), but did not differ from each other. On a 0 = "smooth" to 3 = "rough" scale, most often HAND resulted in "smooth" surfaces (10/20), the powered tips of all types "slight" surface roughness (10/20 each), and US the most "moderate" roughness (7/20). There were no differences in percent calculus remaining, surface roughness, or time spent among the 3 treating clinicians despite their varying experience levels. The results of this study showed that percent calculus remaining was <5% with all the instruments given time ad libitum on a given root surface. Root roughness was generally slightly greater with all 3 powered tips. All of the powered instruments took significantly less time than the HAND. Both DIAM tips took less time than US. Diamond-coated ultrasonic tips appeared to be much more efficient than HAND or US in removing calculus in moderate-deep probing depths on single-rooted teeth in vivo.

Effect of treatment concentration on lipopolysaccharide affinity for two alloys

OBJECTIVE

This study compared gram-negative bacterial lipopolysaccharide (LPS) adherence to and elution from a Type III gold and a Ni-Cr-Be alloy using Escherichia coli LPS.

METHOD

One-half of the specimens of each alloy were pre-treated with 500 micrograms non-radiolabeled E. coli LPS for 24 h at 37 degrees C. All disks were then incubated with 0.15, 15 or 150 micrograms radiolabeled E. coli LPS for 24 h at 37 degrees C. To evaluate radiolabeled LPS elution, specimens were transferred to LPS-free water and incubated for 24 h at 37 degrees C. The elution scheme, which consisted of 24 h incubations and subsequent transfer to new LPS-free water, continued for up to 96 h total elution. Radiolabeled LPS adherence and elution was determined through liquid scintillation spectrometry. Control disks not treated with LPS were evaluated throughout the study with an enzymatic assay to ensure that extraneous LPS contamination did not occur. A multifactor ANOVA (p = 0.05) was used to evaluate differences in adherence to alloy specimens based upon alloy type, pretreatment status and [3H]LPS concentration. A repeated measures analysis ANOVA (p = 0.05) was used to evaluate differences in elution patterns among groups over time. Least square means were compared in case of significant effects.

RESULTS

Toxin uptake at each treatment concentration was significantly different from the other treatment concentrations. In addition, significantly greater amounts of [3H]LPS eluted from the non-pretreated Ni-Cr-Be alloy following the 0.15 and 15 micrograms radiolabeled [3H]LPS treatment, whereas no difference in elution was found among experimental groups following the 150 micrograms [3H]LPS treatment.

SIGNIFICANCE

E. coli LPS, an LPS type representative of enteric bacteria common to the gingival sulcus, has differing affinities for the alloys. This affinity difference could influence periodontal inflammatory processes, thereby resulting in differing tissue responses adjacent to dental restorations fabricated from these materials. The interaction of other LPS types with these alloys could differ.

Comparison of lipopolysaccharides from Bacteroides, Porphyromonas, Prevotella, Campylobacter and Wolinella spp. by tricine-SDS-PAGE

Lipopolysaccharides (LPSs) of 11 bacterial strains from the type species of the genera Bacteroides (B. fragilis), Prevotella (Pr. melaninogenica), Porphyromonas (Po. gingivalis), Campylobacter (C. fetus subsp. fetus), and Wolinella (W. succinogenes), and from the type strains of B. distasonis, B. forsythus, B. ureolyticus, Po. levii, Po. macacae, and C. gracilis, were extracted with hot water-phenol (Westphal method). S-form LPSs, obtained from all organisms, were well resolved with tricine-sodium-dodecyl-sulphate polyacrylamide gel electrophoresis and visualized by silver staining. Lipid A was not stained. Also profiles from LPS of Escherichia coli, serotypes 0111:B4 and 055:B5, could be distinguished. While W. succinogenes showed a relatively short S-form LPS on electrophoregrams, the other bacteria, including B. fragilis, exhibited long-ladder LPSs. Po. gingivalis displayed the largest number of bands and the longest O-chain. The long O-chain of this bacterium may be important for its virulence.

Lipopolysaccharide affinity for titanium implant biomaterials

STATEMENT OF PROBLEM

Lipopolysaccharide (LPS) affinity for titanium implant biomaterials could affect crevicular LPS concentrations and thereby influence periimplant inflammation.

PURPOSE OF STUDY

The purpose of this study was to evaluate Porphyromonas gingivalis and Escherichia coli LPS affinity for titanium biomaterials groups that differed in surface oxide composition and surface roughness.

MATERIAL AND METHOD

Polished and abraded grade 1 commercially pure titanium and grade 5 alloyed extra low interstitial titanium specimens were treated with 10 EU/mm2 and radiolabeled LPS.

RESULTS

The resultant mean +/- SD LPS adherence values ranged from 4.17 +/- 0.29 to 4.79 +/- 0.40 EU/ mm2. No difference in adherence and elution was indicated on the basis of LPS type, surface oxide composition, or surface roughness. Moreover, P. gingivalis and F. coli LPS desorption was below detection.

CONCLUSION

Clinically, the high affinity of both LPS types for titanium biomaterials may adversely influence the periimplant tissue response.

Root surface removal with diamond-coated ultrasonic instruments: an in vitro and SEM study

Adequate root preparation in periodontal procedures includes the removal of plaque, calculus, and perhaps contaminated cementum and dentin. The purpose of this study was to evaluate and compare the amount of root surface removal and residual surface texture using similarly shaped regular (US) and both fine (FINDIAM) and medium (MEDDIAM) grit diamond-coated ultrasonic inserts. Forty-five (45) premolars extracted for orthodontic reasons were randomly divided into 3 groups of 15 teeth each. They were individually mounted in a jig and instrumented with a standardized 500 gram force while they were moved a precise horizontal distance of 12 mm over a 1.2 second period using specially designed and computer controlled instrumentation. Three measurements were made to the nearest 0.0005" at 3 points along the test area before instrumentation and after 10 and 20 strokes. The mean depth of root structure removed was US 5.8 +/- 6.6 microns, FINDIAM 50.1 +/- 14.2 microns, MEDDIAM 30.8 +/- 12.1 microns, after 10 strokes, and US 12.7 +/- 10.9 microns, FINDIAM 83.3 +/- 20.1 microns, MEDDIAM 58.7 +/- 17.9 microns after 20 strokes, respectively. All 3 instruments were different from each other (P < 0.001) in the 10 stroke group, while in the 20 stroke group FINDIAM and MEDDIAM were different from US (P < 0.001), but not from each other. Only FINDIAM showed a significant difference between 10 and 20 stroke values for depth of root removal. Modified loss of tooth substance index SEM scores indicated increasingly greater root surface roughness from US to FINDIAM to MEDDIAM. Substantially greater root surface removal and greater residual root surface roughness occurred with diamond-coated ultrasonic inserts under standardized in vitro conditions. These results suggest that caution should be used with diamond-coated ultrasonic instruments during periodontal root planing procedures.

Porphyromonas gingivalis endotoxin affinity for dental ceramics

This study evaluated the effects of chemical composition, surface treatment, and initial exposure dose on Porphyromonas gingivalis lipopolysaccharide adherence to and elution from dental ceramics. Lipopolysaccharide, commonly known as endotoxin, can initiate a variety of biologic responses. Opaque, body, and Dicor ceramic disks were individually exposed to 250, 1000, or 2500 EU/ml 3H-lipopolysaccharide and incubated for 24 hours at 37 degrees C. Disks were then transferred to fresh lipopolysaccharide-free water and incubated for up to 96 hours to evaluate elution. Mean initial lipopolysaccharide adherence ranged from 0.397 +/- 0.048 EU/mm2 to 5.056 +/- 0.117 EU/mm2. Greater initial exposure levels resulted in greater adherence, and at higher lipopolysaccharide exposure levels, lipopolysaccharide adherence differences were based on ceramic type. Mean lipopolysaccharide elution levels ranged from 0.063 +/- 0.02 EU/mm2 to 0.00 EU/mm2 at 96 hours for all groups. Greater initial adherence resulted in greater elution. Ceramic type did not affect elution. Surface finish affected elution at the 2500 EU exposure level. The affinity of lipopolysaccharide for dental ceramics could contribute to a periodontal inflammatory process.

Porphyromonas gingivalis lipopolysaccharide affinity for two casting alloys

With the exception of plaque, the affinity of biologically active bacterial products for restorative materials and the influence of that affinity on periodontal health has not been detailed. This study recognized that Porphyromonas gingivalis endotoxin, which is cell envelope lipopolysaccharide (LPS) produced by a bacterium that is common to the crevicular microbial flora, has an affinity for dental casting alloys. Regardless of surface finish, no difference in LPS initial adherence or elution was recorded between a type III gold or nickel-chromium-beryllium alloy (p > 0.05), but LPS readily adhered and remained attached to both alloys. LPS affinity could contribute to periodontal inflammation in tissues that approximate restorations fabricated from either alloy.

Critical issues in periodontal research

The purpose of this paper is to highlight briefly the major achievements and the remaining critical issues in the areas of epidemiology, microbiology, pathogenesis, diagnosis, and therapy. Periodontitis affects a relatively small proportion of study populations in the United States and other countries. Prevalence may be decreasing, but that remains to be seen. The identity and characteristics of susceptible individuals and groups are not known, and risk indicators for severe disease are only beginning to be identified. A very large number of different microbial species has been implicated in the etiology. It seems unlikely that all of these are essential participants. Essential participants need to be identified and better characterized. Whether putative pathogens are members of the commensal flora or exogenous species that must be transmitted is unclear. The relationship between the presence of a pathogenic flora and disease status is obscure. Pathogenic bacterial species are essential, but insufficient to cause disease. A susceptible host and local environmental factors--for example, elevated iron concentration--may be necessary for disease to occur. Many clonal types may not be virulent, and numbers greater than certain threshold levels appear to be necessary. The pathways by which bone and connective tissues of the periodontium are destroyed are sufficiently understood to permit development of therapies aimed at their modification. Examples are the use of vaccines, topical application of anti-inflammatory drugs, and use of chemically modified tetracyclines.

Endotoxin affinity for provisional restorative resins

PURPOSE

This study compared the relative affinity of Porphyromonas gingivalis and Escherichia coli endotoxin, bacterial cell envelope lipopolysaccharide (LPS), for three provisional resins.

MATERIALS AND METHODS

As-polymerized and pumiced polymethyl methacrylate and polyethyl methacrylate resin discs were exposed to 1,000 endotoxin U/mL P. gingivalis or E. coli LPS in water for 24 hours at 37 degrees C, whereas control discs were placed in LPS-free water. LPS-treated discs were transferred at 24-hour intervals to fresh, LPS-free water for up to 96 hours, and the incubated eluates were tested for the presence of LPS.

RESULTS

Initial adherence of P. gingivalis LPS to as-polymerized and pumiced-finish resin was a function of resin type, but surface characteristics modified adherence levels. When steady rates of elution were reached at 72 to 96 hours, as-polymerized specimens released significantly greater LPS levels than pumiced samples. Comparison of initial adherence of P. gingivalis and E. coli LPS with pumiced resins showed that adherence was based on a combination of LPS and resin type. P. gingivalis LPS had a greater relative affinity for polyethyl methacrylate, and E. coli LPS has a greater relative affinity for polymethyl methacrylate. Regardless of resin type, P. gingivalis LPS eluted at levels greater than E. coli LPS.

CONCLUSIONS

The affinity of LPS for provisional resins seems to be a function of selective interactions based on the chemical nature of the resin, the surface finish of the resin, and the molecular structure of the LPS.

The effect of root conditioning with minocycline HCl in removing endotoxin from the roots of periodontally-involved teeth

Noting the acid-conditioning effect of minocycline on the root surface, we investigated the ability of minocycline to remove endotoxin on untreated, diseased cementum in vitro. Root surface specimens affected by periodontal disease were immersed in minocycline solution (10 mg/ml, 50 micrograms/ml, and 5 micrograms/ml) for 10 minutes, 1 day, 3 days, and 7 days, and endotoxin eluted was determined by the limulus amoebocyte lysate (LAL) assay. Specimens serving as controls were treated by immersion in pyrogen-free water, agitation, polishing, or exposure to citric acid (pH 1.0) for 3 minutes. When the period of immersion was the same, the root treatment with minocycline (10 mg/ml) yielded a significantly higher rate of neutralization of endotoxin than that with a 5 micrograms/ml or 50 micrograms/ml solution. However, the detoxifying effect of this method was less adequate than that of polishing or treatment with citric acid solution. There was variability in the effects of polishing among the teeth tested. To obtain the expected effect of the root treatment with minocycline solution; i.e., removal of the endotoxin, the combining of minocycline with a mechanical root preparation, such as polishing or root planing, seems to be effective.

Analysis of the attraction of haemocytes from Mytilus edulis by molecules of bacterial origin

Boyden chamber assays were performed to test the stimulatory effect of different bacterial products on the migratory activity of Mytilus haemocytes. The results indicate that these blood cells exhibit chemotactic as well as chemokinetic reactions. Lipopolysaccharides (LPS) from both Serratia marcescens and Escherichia coli stimulated the migration of cells through the membrane of the Boyden chamber when LPS was present in the lower compartment only. In contrast, addition of LPS to the lower as well as to the upper chamber did not increase the rate of migrating cells. Thus, LPS seemed to act as a chemotaxis-stimulating substance. Further analysis indicated that complete LPS molecules are required for cell stimulation because this did not occur when either the lipid or polysaccharide moieties of LPS were tested alone. Unlike LPS, the formylated tripeptide N-FMLP stimulated random cell migration. The peptide, which is released by bacteria, induced a higher haemocyte motility when present in both wells of the Boyden chamber than in tests where it was added to the lower compartment only. This chemokinetic response was not stimulated by the tetrapeptide N-FMLPLys. These findings demonstrate that bacterial products may elicit chemotactic and/or chemokinetic reactions in haemocytes from an invertebrate, and that the type of reaction that occurs is dependent upon the nature of the molecules presented.

The periodontally-involved root surface

Recent years have seen much research on the periodontally-involved root surface. Many of these studies have produced results which suggest that plaque contaminants of the root surface are only superficially placed, and capable of being removed by gentle means. Further research has attested to the difficulties in rendering periodontally-involved root surfaces free of calculus deposits by instrumentation, yet clinical studies show that periodontal disease can be managed by root planing. It is concluded that root surface debridement is best assessed on the basis of the healing response and that it should aim to disrupt plaque on and remove plaque from the periodontally-involved root surface rather than to remove part of the root surface itself.

A localized absence of interleukin-4 triggers periodontal disease activity: a novel hypothesis

Pathogenic bacteria constitute the primary extrinsic agent in the etiology of Adult periodontitis. In addition to direct toxic effects, bacteria induce destructive immunologic and other inflammatory reactions in the host, leading to the observed pathologic alteration in the tissue. The risk to develop periodontal disease is not equal for all individuals, suggesting host factors are important in determining an individuals disease susceptibility. Regulation of immune response is important in maintaining the equilibrium between periodontal health and disease. We hypothesize that, in the case of Adult periodontitis, a localized lack of the regulatory cytokine interleukin-4 (IL-4) in the gingival tissues predisposes susceptible individuals to progress from gingivitis to periodontitis.

Periodontal response to mechanical non-surgical therapy: a review

This literature review is concerned with the ability of personal oral hygiene and mechanical instrumentation to establish and maintain periodontal health. Clinical, microbiologic, and histologic responses to non-surgical therapy are evaluated to provide guidelines for expected treatment results. Factors that may limit the effectiveness of non-surgical therapy as a closed procedure are also addressed. These include length of therapy, skill of therapists, patient compliance, responsibility of clinician for maintenance, and disease activity status of the patient.

Concurrent lipopolysaccharide enhances chemotactic response of human polymorphonuclear leukocytes to bacterial chemotaxin

Polymorphonuclear neutrophil (PMN) function is thought to be critical in resistance to infectious agents and this implies that the PMN must be able to migrate into, and to function in, environments that may have high levels of bacterial lipopolysaccharide (LPS). Therefore, we have evaluated the effect of LPS on the in vitro migration of PMNs. Our data reveal that the human PMN is resistant to the deleterious effects of high levels of LPS, that in high concentrations LPS is, itself, a direct chemoattractant for PMNs, and that PMN migration toward a bacterial chemotaxin is enhanced if LPS is also present. Such capabilities suggest that the PMN may be uniquely qualified to migrate into microenvironments that are rich in LPS.

A novel hypothesis concerning the mechanisms of activation, and of control, of periodontal bone loss

Chronic inflammatory periodontitis fulfills the classical definition of an infectious disease in that it is a disease of the host caused by the activities of one or more parasites. Typically, the etiology of an infectious disease has been defined as the specific microbe which incites the disease process, even though the quality and nature of host responses to the pathogen may underlie much of the pathology seen. This approach in the study of the etiology of chronic periodontitis has not resulted in the identification of a single 'periodontopathogen', but rather is leading to the realization that multiple sets of microbes may induce the same endpoint, albeit some possibly more efficiently than others. The premise of this paper is that a different view of the literature in the area, with the primary emphasis on the mechanisms of damage and resistance to periodontitis, reveals a probable commonality, rather than a plethora of diseases. The concept of a mechanism-based etiology, rather than of a microbe-based one, deserves consideration for this complex, host-parasite interaction. The novel hypothesis presented here is that the common virulence factor of chronic periodontitis is lipopolysaccharide (LPS), that the central damaging mediator is a cyclooxygenase product of arachidonic acid (probably prostaglandin E2), and that the critical resistance mechanism that limits disease activity is the effective, peripheral neutralization of LPS by emigrated polymorphonuclear neutrophils.

The distribution and quantitation of cementum-bound lipopolysaccharide on periodontally diseased root surfaces of human teeth

The aim of this study was to estimate the concentration of cementum-bound LPS on a group of 12 teeth that had been extracted because of periodontitis. LPS on scaled root surfaces was labelled by immunogold/silver staining. The concentrations of LPS were estimated by quantifying the amount of bound silver label, using X-ray microanalysis in areas free of plaque or calculus. These were compared against standards of known LPS concentration, which were separately prepared for each sample. Cementum-bound LPS was detected at concentrations of up to 2 EU/mm2 of affected root surface. However, most of the root surfaces had considerably lower concentrations than this, the mean of all samples never exceeding 0.7 EU/mm2. LPS concentrations were highest on cementum towards the apical regions of the affected pocket. These findings confirm that cementum-bound LPS is only present in low concentrations on affected teeth, and suggest that the clinical significance of cementum-associated LPS may have been over-estimated in the past. The demonstration of LPS appears to be more important as an indicator of retained bacteria and calculus than of cementum-bound LPS per se.

Effects of an air-powder abrasive device used during periodontal flap surgery in dogs

An air-powder abrasive system, the Prophy-Jet, is a commercially available product product intended for use during dental prophylaxis procedures. The purpose of this investigation was to assess the effects on periodontal tissues when the device is used as an adjunct to hand instrumentation in root preparation during periodontal surgery. The degree of tissue injury was assessed by evaluating clinical healing and by histometric analysis of the intensity of the inflammatory response at selected healing times. Surgical sites subjected to Prophy-Jet treatment tended to have slightly lower histometric inflammation scores than control sites treated by hand instrumentation alone. As judged by the inflammatory response and clinical healing, additional effects to surgical exposure of tissues of the periodontium were benign. Use of the Prophy-Jet instrument during periodontal surgery is effective and well tolerated.